Conference Review: 2017 End Well Symposium – Design for the End of Life Experience
By Lizzy Miles (@LizzyMiles_MSW)End Well advertised itself as“a first of its kind gathering of design, tech, health care and activist communities with the goal of generating human-centered, interdisciplinary innovation for the end of life experience.”  I feel privileged to have been able to attend. The Symposium was capped at 400 attendees and sold out early. There was a serendipitous momentary technology glitch that allowed me and two friends to register after it was sold out. Fortunately, the organizers graciously agreed to squeeze us in since we had paid.The single-day event took place at the Interconti...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 11, 2017 Category: Palliative Care Tags: end of life End Well miles Source Type: blogs

National Hospice and Palliative Care Month: Divide and Conquer
by Christian Sinclair (@ctsinclair)Now thatNational Hospice and Palliative Care Month (NHPCM) is in the books for 2017, December is a good time to reflect on what these awareness months can (and cannot) accomplish and how we can make a better strategy for the future. Awareness campaigns have blazed brightly through the bracelet and ribbon eras, and are firmly in the social media era with no signs of stopping (other than possibly fatigue from so much awareness about awareness campaigns.)No single group is technically is in charge of National Hospice and Palliative Care Month. Very few calendar-based advocacy campaigns (CBAC...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 4, 2017 Category: Palliative Care Tags: hospice palliative sinclair The profession Source Type: blogs

The Emotions of the Dying
By Lizzy MilesIn my role as a hospice social worker, I find that there are recurring concerns expressed by family and friends of the dying. These are some of my responses to their worries. Mostly I find that I am normalizing behavior that they find confusing or unsettling, while also validating their discomfort. Families often feel helpless and I do my best to reassure them that what is happening with the patient is part of the process of dying.I am careful to be mindful of faith/cultural beliefs of the patient and family so as to not suggest an explanation that is outside of their dogma.RestlessnessRestlessness is a commo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 1, 2017 Category: Palliative Care Tags: dying emotions letting go life review lizzy miles restlessness social worker Source Type: blogs

Documentation Design: Palliative Care Notes in the EHR Era
by April Krutka (@April918) and Christian Sinclair (@ctsinclair)DOCUMENTATION...who knew this one word could provoke so many emotions among health care clinicians? Say this word, and you will hear stories of triumph and defeat. From universal required elements in the admission history and physical, progress notes and discharge summaries to the specialty specific language of advance care planning and pain assessments, there is a constant pressure to get all the pieces to fit correctly. Moving from analog to digital offered much hope, but also new problems. Before we even start typing or dictating a new note, most of the suc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 27, 2017 Category: Palliative Care Tags: documentation krutka sinclair Source Type: blogs

LGBTQ at the End-of-Life: Needs and Challenges
By Vivian LamHolistic care is essential in the mission to fully meet a patient's needs. And a holistic perspective is the backbone of end of life and palliative care--it's the basis of having an interprofessional team that acknowledges that quality of life is multifaceted, and lives are diverse. But getting to know a patient enough to be able to be " holistic " can be difficult. And in the case of LGBTQ individuals, getting to know the patient as a whole is not only all the more important —it’s integral.According to a2016 Gallup survey, 4.1% of U.S. adults openly identify as LGBTQ, or around 10 millio...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 13, 2017 Category: Palliative Care Tags: closet end of life gay hospice lesbian LGBT LGBTQ palliative transgender vivian lam Source Type: blogs

Defining Dignity at End of Life: One Question to Ask Hospice Patients
By Lizzy MilesI start every new hospice patient interaction with a hello. I introduce myself and then ask for permission to sit and visit. It is not uncommon for the patient to start off on guard, wary. By the time patients meet me, they have been through a lot of medical interactions. They have been asked a lot of questions.I tell them I have just one question. I sometimes notice an exhale.Whew. She ’s not going to grill me.Dignity In Care, developed from research byDr. Harvey Max Chochinov, starts with the Patient Dignity Question (PDQ). It is a simple, open-ended question: “What do I need to know about you a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 4, 2017 Category: Palliative Care Tags: Chochinov Cubs dignity dignity therapy hospice lizzy miles social worker Source Type: blogs

Conference Review: 2017 Palliative and Supportive Care in Oncology Symposium - Day 1
by Christian Sinclair (@ctsinclair)It is a testament to the growth and mainstream acceptance of palliative care, that there is a sub-sub-specialty two-day conference like the#PallOnc conference held in San Diego this past weekend. If you have not heard of this meeting yet, and the majority of your work in that intersection between oncology and palliative care, I would highly recommend considering it in the future. This is the 4th consecutive year the meeting has been held, and I applaud the commitment of the four co-sponsoring organizations (AAHPM, ASCO, ASTRO and MASCC). Kristina Newport and Shanthi Sivendranreviewed this...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 30, 2017 Category: Palliative Care Tags: conference reviews oncology palliative sinclair Source Type: blogs

Quality Improvement – The Science of Making Care Better for All
by Arif Kamal (@arifkamalmd)It seems everywhere a person turns, there ’s nonstop discourse regarding healthcare quality, particularly the relationship of meeting quality metrics to demonstrating lower costs and higher value. As palliative care further immerses itself into usual healthcare delivery, it behooves our workforce to adeptly apply quality improvement skil ls to translate our sense of “what is right” into the usual practice of “what is done.” Meeting these demands takes skills and practice, rooted in an evolving evidence base around quality improvement science.It may confuse some to h...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 23, 2017 Category: Palliative Care Tags: conference kamal quality Source Type: blogs

Building Certification for Hospice and Palliative Care Social Workers - Take the Survey!
by Megan Mooney(Take the Hospice and Palliative SW Job Analysis survey before October 5th if you are a social worker. If you are not a social worker,encourage social workers in hospice and palliative care that you know to take it!)What is Evidence Based Practice?The Institute of Medicine (2001) defines evidence-based medicine as “the integration of best researched evidence and clinical expertise with patient values” (p. 147). According to Social Work Policy Institute (2010) evidence-based practice (EBP) is defined as the combination of research interventions, clinical experience, values, and client preference t...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 2, 2017 Category: Palliative Care Tags: mooney social work social worker Source Type: blogs

Palliative Care in the Time of Hurricane Harvey
by Ishwaria Subbiah (@IshwariaMD)Trouble BrewingBetween the network news and many institutional emails on hurricane preparations, we at MD Anderson knew were in for something ‘big.’ Harvey made landfall on August 25th as a Category 4 hurricane about 190 miles southwest of Houston. The outer bands brought rain without any major disruptions to our practice. As expected, upon landfall, Harvey rapidly weakened but stalled over Texas. The subsequent two days brought a level of rainfall best described as apocalyptic. The institution’s leaders activated the ‘ride-out’ team where the core essential ph...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 27, 2017 Category: Palliative Care Tags: disaster hurricane subbiah The profession weather Source Type: blogs

Moving From Research to Implementation to Research in Palliative Care, Part 1
by Christian SinclairIn 2003, I began my hospice and palliative medicine (HPM) fellowship in Winston-Salem, NC. I was a solo fellow in a new program, and as luck would have it, I had loads of time to dedicate myself to learning. Since my wife, Kelly, was beginning her pediatric emergency medicine fellowship in Kansas City at the same time, I only had my dog and my fellowship to worry about. I always enjoyed reading articles and imagined how it would apply in my own practice. But when it came down to it, I was never really able to implement much of what I was reading, let alone have the numbers to benchmark against the rese...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 25, 2017 Category: Palliative Care Tags: ESAS non-pain symptoms quality research research issues Source Type: blogs

Lorazepam, Haloperidol, and Delirium
JAMA Internal Medicinehas published a double-blind,randomized, placebo-controlled trial of adding lorazepam to haloperidol in patients with advanced cancer and agitated delirium. (We had a heads up about this trial because it waspresented at ASCO earlier this year.) If there ever was a sort of consensus in HPM about how we should be treating delirium, my sense is that it ’s been shattered by the recentRCT of low-dose haloperidol vs risperidone for delirium in Australian palliative care unit patients, showing those drugsworsened delirium symptoms. So, it seems like we should all see what we can learn from this newly p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 25, 2017 Category: Palliative Care Tags: antipsychotics delirium research issues rosielle Source Type: blogs

Preparing to Show Up: Writing Practices that Serve
by Jennifer WilhoitSeveral months ago I wrote a piece for this blog aboutnature practices we can do in hospice settings, and when preparing for visits with families and people who are dying. I stressed the vital importance of self-care as we serve individuals with such acute and ever-changing needs. I also reminded the reader that we do not engage our hospice work in a vacuum, but as ordinary humans ourselves with the vagaries of everyday life pressing in on us. We show up to our families and friends; we show up to those we are called to serve in hospice contexts. But how well do we remember to show up to ourselves with su...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 20, 2017 Category: Palliative Care Tags: hospice intervention Jennifer Wilhoit nature nurture reflect self care Self reflection TEALarbor volunteer writing Source Type: blogs

“Going Palliative” is Not a Thing
by Staci MandrolaI love the segment onLast Week Tonight with John Oliver called “How is this still a thing?” His snarky Britishness targets everything from the Sports Illustrated Swimsuit issue to ‘Why do we dress up as other races?’ The skits start out funny but leave you questioning and unsettled.I hope “going palliative” ends before it shows up on “How is this still a thing?” How do I know " going palliative " is a thing? The phrase is popping up in the academic medical center where I practice palliative care. [And many other hospitals too - Ed.] PT/OT has s...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 18, 2017 Category: Palliative Care Tags: culture hospice mandrola palliative Source Type: blogs

Privilege and Palliative Care
by Denise HessAn American pastor recently visited Australia and encountered a curious practice. At the start of meetings, any kind of meeting not just religious ones, she found it is common practice to begin with what is called an “acknowledgment of country.” According to reconciliation.org.au:An Acknowledgement of Country is an opportunity for anyone to show respect for Traditional Owners and the continuing connection of Aboriginal and Torres Strait Islander peoples to Country. It can be given by both non-Indigenous people and Aboriginal and Torres Strait Islander people.And it goes something li...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 11, 2017 Category: Palliative Care Tags: culture hess open access psychosocial race Source Type: blogs

How HBO's The Leftovers Parallels Our Work in Palliative Care
By Shayna Rich and J. MaggioThe HBO showThe Leftovers has a deceptively straightforward science fiction premise: What happens to people left behind after a Rapture-like event? The Rapture is an apocalyptic event prophesied in the New Testament where people chosen by God disappear into Heaven. In the show, roughly two percent of the world ’s population--about 140 million people--mysteriously disappear in an instant. Unlike the popular Christian book and film seriesLeft Behind, The Leftovers is agnostic to the cause of the sudden departure. Some characters believe it was the Christian Rapture, but other characters disa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2017 Category: Palliative Care Tags: arts leftovers media spirituality/religion tv Source Type: blogs

The Role of Hospice and Palliative Medicine in Education
Discussion topics:T1: What are the main systemic barriers to good communication in healthcare?T2: What is your favorite education tool? (Think broadly!)T3: What is your favorite “high-yield” question to ask patients? Patients, what’s the one Q you want your HCP to ask?Meredith MacMartin is a palliative care physician atDartmouth-Hitchcock Medical Center in Lebanon, NH. (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 28, 2017 Category: Palliative Care Source Type: blogs

Should Clinicians Be More (or Less) Politically Active?
by Christian SinclairPolitics and healthcare are occupying much of the news cycle this summer with all of the discussions around the possible repeal of the Affordable Care Act (AKA Obamacare). On one hand it can viewed as must-see reality TV with all of the drama and back and forth arguments with passionate opposition. Late-night TV hosts help turn the drama into satire and give everyone a good laugh and some entertainment. Yet it is important to see that this will greatly impact the care of the patients we see every day.To be honest, it was not until a few years ago that I started to see the power of getting more politica...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 26, 2017 Category: Palliative Care Tags: AAHPM health policy politics sinclair tweetchat twitter Source Type: blogs

Choice: The Hidden Curriculum in Palliative Care
By Paul CarrThank you to Dr. Naheed Dosani and the excellent team at William Osler Health Centre for inspiring this post.What three words describe the essence of palliative care for you? When I asked my friends, family, and colleagues, the most common answers are: pain management, personal and spiritual support, and end of life planning. Those are all key components. But what quickly became apparent to me during my palliative care elective is that excellent palliative care providers embrace the role of enabling patients and families to make well-informed choices.I have taken a long and untraditional route to arrive in the ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 17, 2017 Category: Palliative Care Tags: choice communication goals palliative paul carr Source Type: blogs

Palliative Care & CHF: PAL-HF trial
The main results of PAL-HF - a randomized, controlled trial of specialty palliative care team involvement in advanced heart failure patients -  have just been published in the Journal of the American College of Cardiology (DOI: 10.1016/j.jacc.2017.05.030. Clinicaltrials.gov registration here). This is an important, well-done study, with encouraging results - specialty PC improved the quality of life of patients with HF. I'll discuss the results in more details in this post.The study was done by a multi-disciplinary team of palliative& cardiology investigators at Duke. This week's publ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 14, 2017 Category: Palliative Care Tags: chf heart failure research research issues rosielle Source Type: blogs

Upstream Palliative Care and Dissecting Hope From Hype in Oncology
by Christian SinclairWorking in an outpatient cancer center, I frequently encounter the conversation about whether the next cancer treatment regimen is ‘worth it.’ Patients and families consider may interpretations of worth; financial being one of course, but also physical side effects, the emotional toll of investing faith into ‘one more treatment’ and hoping that it works. These conversations are challenging as they weigh biological, medi cal, spiritual, social, personal, emotional and other issues, so there is no neat equation which can easily tell you if the benefits or the risks are greater.The...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 28, 2017 Category: Palliative Care Tags: sinclair tweetchat Source Type: blogs

Perusing ASCO 2017 - AKA Time for Lorazepam
(Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2017 Category: Palliative Care Tags: ASCO cancer oncology pallonc research research issues rosielle WaPo Source Type: blogs

Persuing ASCO 2017 - AKA Time for Lorazepam
Photo from ASCO Mediakit. © ASCO/Danny Morton 2017TheAnnual Meeting of the American Society of Clinical Oncology was last week. It ’s been my observation over the years that much of the best palliative-oncology and supportive-oncology research is presented at ASCO each year, before it’s actually published (if it ever gets published).  So I always dig through the palliative/EOL/supportive/psychooncology abstracts each year to see what's happening. Below is a gently annotated list of the abstracts that caught my eye the most, for your perusal and edification. Undoubtedly, these are my idiosyncratic...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2017 Category: Palliative Care Tags: ASCO cancer oncology pallonc research research issues rosielle WaPo Source Type: blogs

Stand Up! For Each Other as the Year Marches on
By Vickie LeffStand Up! was 2017 ’s theme for Social Work Month. As many of us know, social workers are excellent advocates; advocacy it is a core skill that is integral to our teaching, profession, and interventions. In celebration of that theme, as March concludes, I want to challenge you to spread that enthusiasm and charter a cross the palliative care universe this year. After all, palliative care is a team sport, defining itself not whole until a physician, nurse and social worker (at a minimum, with ideally many more disciplines involved) are members. This is not a random collection of professionals, but a calc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 1, 2017 Category: Palliative Care Tags: advocacy interprofessional self-care social work social worker teamwork Vickie Leff Source Type: blogs

Looking Forward to #hpm Chats in 2017
InJuly 2010, Christian and I had a conversation about finding ways to bring people together online to connect, collaborate and learn more about topics in hospice and palliative care. We had seen some fascinating discussions with#hcsm, the health care social media community and decided to launch the#hpm chat as a weekly interdisciplinary discussion of issues in hospice and palliative care. I never imagined how this idea would develop into such a vibrant community where caregivers, doctors, nurses, social workers, volunteers and people with a variety of experiences have joined in to discuss topics on our weekly conversations...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 28, 2017 Category: Palliative Care Source Type: blogs

Book Review: Gratitude by Dr. Oliver Sacks
By Karen B. KaplanReading Dr. Sacks ’ farewell book with its mournful black cover was like going through a typical day on the job as a hospice chaplain. Just like my patients, this famous author, well-known for his medical narratives such asThe Man Who Mistook His Wife For A Hat: And Other Clinical Tales lists his regrets, his triumphs, his hopes, and his efforts to make sense of the life that he had led. In a word, this book is about how he dealt with his approaching end. Many of us can relate to his regrets, which included wasting time, being shy, and not traveling more. He also hoped to love and work as long ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 20, 2017 Category: Palliative Care Tags: book review gratitude karen Kaplan sachs Source Type: blogs

Why I Became a Certified Hospice and Palliative ICU Nurse
by Lori RuderMarch 19 is Certified Nurses Day, a day set aside to honor nurses who improve patient outcomes through certification in their specialty. The American Nurses Credentialing Center (ANCC) states: “A registered nurse (RN) license allows nurses to practice. Certification affirms advanced knowledge, skill, and practice to meet the challenges of modern nursing.”As an ICU nurse, I see the challenges of modern nursing as witnessing sicker patients undergoing extreme measures; attempting to extend the length of life but not necessarily the quality of life. ICU nurses have 24/7 intimate contact with their pat...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 19, 2017 Category: Palliative Care Tags: credentialing icu nurse nursing ruder The profession Source Type: blogs

Preparing to Show Up: Nature Practices that Serve
This article offers some very basic nature-based practices that we can use on a regular —if not frequent—basis with little preparation in moments in which we find ourselves: depleted, enervated, or in need of clarity. I have been a hospice volunteer for more than sixteen years, while also serving the deep needs of people in transition through my private professional practice. What I’ve learned from both of these endeavors is that showing up to “the other” in an engaged, dynamic manner is not only essential for them; I must show up to myself in such a way, too. We need to maintain a daily conne...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 17, 2017 Category: Palliative Care Tags: hospice intervention Jennifer Wilhoit nature reflect self care Self reflection volunteer Source Type: blogs

On Language: Why We Should Avoid Saying " So Young "
By Amanda HinrichsThere is a brief phrase I hear uttered in the halls of the clinic or the hospital, a phrase I have said myself, and it ’s a phrase that concerns me. This phrase, “so young,” is uttered by new and experienced clinicians, often when talking about patients who are seen as being too young for the illness(es) they have. This phrase conveys objectivity and societal statistics, but is also laden with personal judgeme nt, empathy, and sadness.As I enter my career in adult palliative medicine, I have been thinking more and more about the importance of language and the way we, the medical communit...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 15, 2017 Category: Palliative Care Tags: amanda hinrichs bias label language lifespan palliative young Source Type: blogs

Bringing Humanity Back to Medicine: A Book Review of " Attending " by Ronald Epstein
by Lyle FettigWhen debriefing after a difficult communication encounter led by a fellow or resident, I ’ll often start by asking the trainee, “how do you think it went?” There are times when I thought the encounter went very well, yet the trainee leaves the room with a worried look. Perhaps the trainee clearly explained the medical facts, demonstrated ample empathy, and carefully talked about t he next steps, so I’ll be a bit surprised when the trainee says, “It went horrible.” I’ll ask why, and I’ll get a bemused look in response. “Because I made the patient cry,&rdquo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 1, 2017 Category: Palliative Care Tags: book depression fettig humanity media mindfulness review The profession Source Type: blogs

Extremis Documentary Falls Short at Oscars, Wins Over Palliative Care
by Christian SinclairLast night at the Oscars, there sure was a lot of excitement for many of my friends and colleagues, and I'm not just talking about the surprise ending with La La Land winning Best Picture, then losing it in a tragic mistake of envelopes, to another well-deserving film Moonlight. That is because many of my friends and colleagues are strong advocates and wonderful clinicians who are vocal about excellent care at the end of life.The filmExtremis, which was released in April 2016 at the Tribeca Film Festival, was nominated for An Academy Award for Best Documentary Short Subject, but up against top competit...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 27, 2017 Category: Palliative Care Tags: extremis film sinclair zitter Source Type: blogs

SWHPN 2017 Conference Reflection
By Abigail LatimerAlthough I have three years of hospice clinical social work, I am only six months into my career with inpatient palliative care. I learned aboutSWHPN (Social Work Hospice& Palliative Care Network) and quickly applied and received the scholarship to attend the conference. It was beyond any previously held expectation and I left in awe of the work that is being done from around the country and world. As I sat next to great leaders like Dr. Grace Christ, Terri Altilio, LCSW and Shirley Otis-Green, LCSW, OSW-C (to name a few) I felt humble and as Susan Blacker, MSW, RSW and Susan Hedlund, LCSW, OSW-C...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 26, 2017 Category: Palliative Care Source Type: blogs

Social Media to Enhance the 2017 Annual Assembly
by Christian SinclairThe Annual Assembly of AAHPM and HPNA is right around the corner and if you are going to Phoenix, or staying home to keep things running smoothly, social media can help make your conference experience be transformative. Since 2009, the Assembly has been making use of Twitter to provide additional insight, commentary and sources for the multiple sessions each day. Now things are expanding to dedicated conference apps, Facebook and Instagram. And for the first year ever we have Twitter contests.The official hashtag of the conference:#hpm17 (works on Twitter, Facebook, Instagram), use it in every twe...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 20, 2017 Category: Palliative Care Tags: facebook sinclair twitter Source Type: blogs

Warming Hearts, Cloaking Grief
By Lori RuderHe moves over and she snuggles in close to her fianc é. She pulls their blanket over them. A special blanket made just for this moment. “I love you” she murmurs, soaking in his face and his warmth. “Goodnight lovebirds,” his mother teases as she turns out the lights.This moment is both tender and tragic: tender because they are demonstrating their love for each other, tragic because this is happening in the ICU. Her fianc é is on life support and he is dying. He moved over because I moved him over to make room for her in his narrow hospital bed. I repositioned his ven...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 15, 2017 Category: Palliative Care Tags: blanket cancer comfort icu lori ruder Source Type: blogs

11th Annual Pallimed and GeriPal #hpmParty at #hpm17
Come one, come all to the 11th annual Pallimed / GeriPal party during the Annual Assembly of AAHPM and HPNA! And right after SWHPN's conference too!In keeping with tradition, we will host it on the Thursday of the Assembly (Feb 23rd). We will start atLustreat around 8 PM and move on from there toHanny's at 10pm (and then who knows what). Like always though, these are rough estimates of time, so if you want to know the details, follow the hashtag#HPMparty on Twitter.Also, feel free to invite and bring anyone, as this is no exclusive crowd.Ways to follow: #HPMparty twitter feedPallimed Twitter feed&n...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 15, 2017 Category: Palliative Care Tags: geripal meta party Source Type: blogs

Warming Hearts, Cloaking Grief
By Lori RuderHe moves over and she snuggles in close to her fianc é. She pulls their blanket over them. A special blanket made just for this moment. “I love you” she murmurs, soaking in his face and his warmth. “Goodnight lovebirds,” his mother teases as she turns out the lights.This moment is both tender and tragic: tender because they are demonstrating their love for each other, tragic because this is happening in the ICU. Her fianc é is on life support and he is dying. He moved over because I moved him over to make room for her in his narrow hospital bed. I repositioned his ven...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 15, 2017 Category: Palliative Care Tags: blanket cancer comfort icu lori ruder Source Type: blogs

Is it Death Denial or Death Defiance?
by PJ MoonA phrase in Dr. Dieter ’s recent Pallimed piece, "Facing the Abyss: Planning for Death, " usefully resurfaced a notion I ’ve had for 12 years now. It started when a professor I was working under remarked how the " death denial thesis " may not really be valid anymore in geriatric/end of life publications and discourse.Combing through the literature, my professor ’s hunch rang true, but only faintly so. To be clear, it wasn’t that issues of human mortality were given special spotlight by journal editors and varying authors, but rather the matter was generally portrayed i...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 13, 2017 Category: Palliative Care Tags: death denial death management moon Source Type: blogs

Show us your #PallimedValentines
Last year the NorthEast Palliatiors from Carolinas Healthcare shared part of their team wellness activity with a Valentine's day theme. This year they shared more Valentine's cards they made and even a team-built poem:An Ode to Palliative Care.SinceFebruary is National Heart Month, and Valentine's is next week, we would love to see the creativity of your hospice and palliative care teams! I'm sure you have at least one Interdisciplinary Team meeting next week, and you probably have some time allotted for education or self-care/team wellness, so let's see what you can do!Check out our slideshow below or ouralbum on Facebook...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 11, 2017 Category: Palliative Care Tags: cardiovascular meta UGC Source Type: blogs

An Ode to Palliative Care
Ode to Palliative CareRoses are redViolets are bluePalliative care, we dedicate these love words,Solely to you.You met us where we were at yesterday,Even met with the patient and family again today,Tomorrow you will meet as a given,Forever and always.Palliative care you came along,Asked the tough questions like no one before,Palliative care you spoke to my soul and captured me fully,And forever more.Palliative care I give you my heart,To take care of my family and all that is me,You lit a fire and spark,Can you see?Palliative care you ask me about QOL and make me happy,As only the team approach can,Having you in my corner ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 11, 2017 Category: Palliative Care Tags: frechman pallaitive poetry self-care Source Type: blogs

The Clinical Social Work Role in Interprofessional Practice with Nurses in Palliative Care and Hospice
By Vickie LeffSusan Blacker, et.al provided an excellent article “Advancing Hospice and Palliative Care Social Work Leadership in Interprofessional Education and Practice.” 1 The authors describe the importance of interprofessional collaboration in palliative care, and strategies to address barriers. Increasing curriculum and practice presence are essential to improving this effort.I would like to add and highlight a practical example of interprofessional practice that can:1. help build resilience for nurses2. serve as a model for clinical social work perspective and problem solving3. increase the understa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 10, 2017 Category: Palliative Care Tags: CSW debriefing social work social worker Vickie Leff Source Type: blogs

14 Ways Hospice Patients Have Said They're Ready to Die
Compiled by Lizzy MilesThese are statements made by hospice patient to me over the years indicating their readiness to die." If something is going to happen, let it happen. Life is getting less interesting as the days go by. "" Sometimes I wonder why they've all gone and I'm still here. "" When I go to bed I always wonder if this will be the time I die. "" I've done it all I've seen it all. I could step out. "" I'm ready to get up and jump around "" I'm 93 and anything can happen at any time. I have no qualms. "" I was put on this earth to die. Today is just ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 8, 2017 Category: Palliative Care Tags: hospice lizzy miles quotes ready to die Source Type: blogs

ASCO Supports Concurrent Palliative Care for People with Advanced Cancer
by Christian SinclairTheAmerican Society of Clinical Oncology recentlypublished the strongest call for concurrent palliative care in oncology. Released online on Halloween 2016, and published in the Journal of Clinical Oncology just last month, this Clinical Practice Guideline (CPG) should be in the pocket of every palliative care team as they meet with their oncology colleagues to collaborate on better care for patients.The guideline holds more weight and expands the scope compared to the 2012 Provisional Clinical Opinion which emerged after the Temel article. In 2010,NEJM published a randomized control trial (RCT) of pal...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 7, 2017 Category: Palliative Care Tags: ASCO guidelines non-pain symptoms oncology sinclair Source Type: blogs

Facing the Abyss: Planning for Death
By Kevin Dieter“The hurrier you go, the behinder you get.”Puzzlingly, the older and more “seasoned” I become, the more this bit of Amish wisdom is true. Especially when it comes to reading. I don’t have time to read. So, I was surprised when I found myself reading a recent publication from the National Quality Forum. However, as serendipity would have it, I am so glad I did. This publication, “Strategies for Change: A Collaborative Journey to Transform Advanced Illness Care“ had me hooked with the introduction. They had the beautiful audacity to suggest that physicians can and do h...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 6, 2017 Category: Palliative Care Tags: advanced directives conversation death cafe Dieter Go Wish goals planning for death prepare for death Source Type: blogs

We are mortal humans, we suffer and love, hopefully together, and then we each die.
by Drew RosielleI went into medicine because I thought it'd be something practical, to help people.I majored in English and Religion at the University of Iowa in the early 1990s, and didn't have clear career plans. I guess I thought I'd become an English professor. Late in my undergraduate days I was enamored with the more experimental sides of 20th Century poetry (Gertrude Stein, Lorine Niedecker) and figured I'd go on to grad school. To make ends meet in college, I got a part-time job cleaning a group home overnight for teenage boys with profound developmental disabilities. I liked to stay up late, and I could clean the ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 1, 2017 Category: Palliative Care Tags: ethics ethics/law politics rosielle Source Type: blogs

What Does the Scan Tell Us? An analysis of oncology outpatient visits
Discussions: Insights Into Why Patients Misunderstand Their Prognosis, " which was published online early in the Journal of Oncology Practice. (OPEN ACCESS PDF!)The researchers analyzed recordings of oncologists and patients with stage IIIA, IIIB, or IV non-small cell lung cancer in the outpatient setting. These recordings were from another large study and are over a decade old now. But as the authors pointed out, there is not strong evidence that outpatient communication strategies have changed wholesale in oncology, (although treatment options have changed drastically with the introduction of checkpoint inhibitors, ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 30, 2017 Category: Palliative Care Tags: clinic communication journal article oncology outpatient prognosis sinclair Source Type: blogs

AAHPM/HPNA 2017 Annual Assembly Preview - Overview
by Christian Sinclair(Join up with other Pallimed readers going to the Annual Assembly on the Facebook Events page.)In less than a month, more than 3,000 nurses, physicians, and others will be gathering in Phoenix, AZ to attendThe Annual Assembly of Hospice and Palliative Care (PDF Brochure here).The Assembly returns to Phoenix for the first time since the 2004 meeting, which also happened to be my first Annual Assembly. The 2004 meeting was held in a small resort (Tapatio Cliffs!) a little north of Phoenix. This year we are in the main convention center because it has grown so much over the years.This year's Annual A...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 28, 2017 Category: Palliative Care Tags: AAHPM conference conference reviews sinclair TEDMED twitter Source Type: blogs

Changing Treatment Options in Delirium - No More Antipsychotics?
by Drew RosielleIntroductory CommentsThis is a post to share my thoughts about therandomized, controlled trial of haloperidol, risperidone, or placebo for delirium in'palliative care'patients, published recently in JAMA Internal Medicine.Big hat tip to my fellows - Drs Amanda Hinrichs, Elena Wahmhoff, and Alison Feldman, whose discussion of the paper at a recent fellows'rounds helped me think through the study, as well as theAAHPM Connect communities bulletin board's discussions (BTW, have really appreciated these bulletin boards the last couple years and am grateful to AAHPM for pulling it off so well!).Geripal, as per us...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 28, 2017 Category: Palliative Care Tags: antipsychotics delirium journal article MDAS NuDESC rosielle Source Type: blogs

The Dying Don ’t Need Your Permission to Let Go
This article is the seventh in a series of articles where I take each assumption from the original article and explore the concept in greater depth to include implications and possible interventions. In my last article, I wrote about theassumption that hospice patients will reveal the secrets to the universe.Here is our next assumption: You should tell your loved one, “It’s okay to let go.”The idea that a dying person is waiting for permission from their loved ones permeates many articles about the final days of dying. There is some truth to the idea that some patients may linger because they worry about ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 20, 2017 Category: Palliative Care Tags: assumptions bedside family intervention lizzy lizzy miles social work social worker Source Type: blogs

#hpm Chat on Hiatus until Spring 2017
by Christian Sinclair (@ctsinclair)As another year starts winding down, it is always a good reminder to take stock of what you value. After 319 weekly chats in 6.5 years, #hpm chat is going on our first ever hiatus. This was a hard decision for Meredith MacMartin and myself, the two lead co-moderators. We have had numerous conversations about the sustainability of weekly #hpm chats going into 2017 with only two co-moderators. There is a lot of work that goes into developing weekly programming, making sure the hosts are ready, ensuring diverse topics and hosts, editing blog posts, and promoting the chat. And that is all bef...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 15, 2016 Category: Palliative Care Tags: hpmchat sinclair tweetchat twitter Source Type: blogs

Decision Making at the End of Life: Joint #patientpref and #hpm Tweetchat
By Meredith MacMartinFred was a sick guy. He had been diagnosed with COPD years ago, and more recently developed heart failure, and although he and his wife Nancy tried to stick with his medication regimen and monitor his salt intake, his shortness of breath had been making it harder and harder to even get around the house. He followed regularly with his primary care doctor, and talked about what he would want in terms of medical care if and when he got sicker. His wife knew that he didn ’t want to go to the hospital if it could be avoided, and that he definitely did not want to end up in an ICU on a ventilator, or g...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 7, 2016 Category: Palliative Care Source Type: blogs